Jirawit Khaomuangnoi, MD¹, Seubtrakul Tantalanukul, DrPH²

Objective: To develop and comprehensively evaluate a one-day surgery system for elderly patients in community hospitals, examining feasibility, clinical safety outcomes, success factors, patient-reported outcomes, and cost-effectiveness.

Materials and Methods: The present study was a mixed-methods study conducted at Laplae Hospital, Uttaradit, Thailand, between November 2024 and October 2025. Forty-one elderly patients, aged 60 years and older, who underwent one-day surgery procedures were included. The system development involved three main components: screening and preparation, surgery and post-operative care, and post-discharge follow-up. Quantitative data included clinical outcomes and quality of life (EQ-5D-5L) assessed at baseline, 7 days, and 30 days post-surgery using paired t-test analyses. Qualitative methods explored success factors through in-depth interviews with patients/caregivers (15 participants) and focus groups with healthcare providers (14 participants). Cost-effectiveness analysis compared one-day surgery with conventional hospitalization using propensity score-matched historical controls (41 pairs).

Results: The one-day surgery system achieved a 95.1% success rate, with only two patients requiring overnight hospitalization. Most patients (87.8%) experienced no complications, with minor complications (12.2%). Pain scores showed a biphasic pattern, increasing significantly at seven days post-surgery compared to baseline (5.2±2.3 versus 3.8±1.9, p<0.001), then decreasing by 30 days (2.1±1.5 versus 3.8±1.9, p<0.001). Quality of life demonstrated parallel trajectories, with temporary deterioration at seven days (0.68±0.16 versus 0.72±0.14, p=0.047) followed by significant improvement at 30 days post-surgery compared to baseline (0.81±0.12 versus 0.72±0.14, p<0.001), exceeding the minimal clinically important difference. Key success factors included appropriate patient selection, caregiver readiness, multidisciplinary teamwork, and effective post-discharge monitoring. Cost-effectiveness analysis showed one-day surgery was 26.04% (6,026.14 THB per patient) less expensive than conventional surgery while providing better health outcomes (QALY gained 0.0257 versus 0.0238). Probabilistic sensitivity analysis confirmed dominance in 92.5% of simulations.

Conclusion: One-day surgery for elderly patients in community hospitals is feasible, safe, and cost-effective when implemented with appropriate patient selection and comprehensive support systems. The biphasic recovery pattern with peak pain at seven days highlights the need for enhanced early postoperative pain management protocols. This approach offers a promising solution for addressing the surgical needs of the growing elderly population in resource-limited settings.

Received 28 April 2025 | Revised 26 October 2025 | Accepted 30 October 2025

DOI: 10.35755/jmedassocthai.2026.4.03081